炎症和chd流行病学：hs-crp证据.pptVIP

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炎症和chd流行病学：hs-crp证据.ppt

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炎症和chd流行病学：hs-crp证据

Epidemiology of Inflammatory Markers and CHD: Evidence for High-Sensitivity C-Reactive ProteinPaul M. Ridker, MD, MPH Beyond Cholesterol: Predicting Cardiovascular Risk In the 21st Century Cardiovascular Risk LipidsHTNDiabetes Behavioral HemostaticThrombotic Inflammatory Genetic Total Cholesterol Distribution: CHD vs Non-CHD Population Castelli WP. Atherosclerosis. 1996;124(suppl):S1-S9. ?1996 Reprinted with permission from Elsevier Science. 35% of CHD Occurs in People with TC200 mg/dL 150 200 Total Cholesterol (mg/dL) 250 300 No CHD CHD Framingham Heart Study—26-Year Follow-up Inflammation and Atherosclerosis Inflammation may determine plaque stability - Unstable plaques have increased leukocytic infiltrates - T cells, macrophages predominate rupture sites - Cytokines and metalloproteinases influence both stability and degradation of the fibrous cap Lipid lowering may reduce plaque inflammation - Decreased macrophage number - Decreased expression of collagenolytic enzymes (MMP-1) - Increased interstitial collagen - Decreased expression of E-selectin - Reduced calcium deposition Libby P. Circulation 1995;91:2844-2850. Ross R. N Engl J Med 1999;340:115-126. Is there clinical evidence that inflammatory markers predict future coronary events and provide additional predictive information beyond traditional risk factors? hs-CRP and Risk of Future MI in Apparently Healthy Men Ridker PM et al. N Engl J Med 1997;336:973-979. 10.055 Relative Risk of MI P = 0.03 Quartile of hs-CRP (range, mg/dL) 20.056–0.114 30.115–0.210 40.211 P 0.001 P 0.001 P Trend 0.001 hs-CRP and Risk of Future MI: Analysis Stratified by Smoking Status Ridker PM et al. N Engl J Med 1997;336:973-979. 1 Relative Risk of Future MI Quartile of CRP 2 3 4 All Patients Nonsmokers hs-CRP and Risk of Future MI: Analysis Stratified by Year of Follow-up Ridker PM et al. N Engl J Med 1997;336:973-979. ?1997 Massachusetts Medical Society. All rights rese